Healthcare Provider Details

I. General information

NPI: 1831904648
Provider Name (Legal Business Name): ELEXIS BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ANNAPOLIS RD STE 225
GLENN DALE MD
20769-9182
US

IV. Provider business mailing address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

V. Phone/Fax

Practice location:
  • Phone: 240-266-5889
  • Fax: 351-214-3692
Mailing address:
  • Phone: 240-266-5889
  • Fax: 351-214-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR248458
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: